There is a strong trend to computerization of medical records. This method of recording information about a patient offers many advantages but also some significant disadvantages. Operational issues may plague the use of electronic medical records, a third issue to consider.

• Physician and nursing resistance to the use of computers is a factor that complicates the introduction of computers to a healthcare setting. Resistance to change is a potent force that can affect the acceptance of terminals. The attorney may be able to see some evidence of this resistance by examining the record of a patient who was hospitalized during the organization’s transition to computerized documentation. The attorney may observe that some of the documentation is done in a manual manner while other providers have used the computer to document. While this may reflect that the healthcare providers have not all gone through training on the computers or with the software, it may also be due to resistance to change. Partial use of the computer and partial use of handwritten entries can create a confusing record. A medical center may decid to adopt electronic order entry and documentation. When some of the physicians resist, the facility may have to maintain two systems for ordering and recording data. This requires the nurses to know which physicians use the EMRs and which do not, increasing the time and risks.
• In these situations the requesting attorney should take extra care to make sure that all records have been received.
• It may be more time consuming for the healthcare provider to navigate through a series of screens in order to select the appropriate data elements than it would to handwrite a brief note. During that interval,t he provider sitting with a patient making a note in a chart may become absorbed in the task. some patients may perceive the provider is spending more time with the computer than with them. Sometimes the task becomes rote, leading to a syndrome called “click happy”, in which the healthcare provider does not carefully read each choice on the screen before clicking it.
• Computer systems may become unavailable due to unexpected crashes or routine downtime. Medical information becomes inaccessible during these times, creating potential for medical errors.
• The adage “garbage in, garbage out” applies to the computer medical record just as it does to other aspects of computer programming. Incidents may increasingly occur in which clearly inaccurate information has worked its way into the medical record (as in auto-population errors, described above), but has not been questioned by healthcare professionals because computerized information is perceived to be infallible. No machine can replace a healthcare professional who can critically evaluate patient data and question information that does not make sense. Attorneys and healthcare personnel must guard against the temptation to deify the computer. Meaningless documentation can also be generated when templates are used without modification or individualization.
• It may be possible for one clinician’s entries to appear as another clinician’s entries if the first person does not sign off the record or log off.
• Healthcare personnel who work at several hospitals may be asked to remember a series of passwords to log into different computers. Unable to keep all of the codes memorized, some personnel keep a list of passwords. The act of writing down passwords in order to use them to access systems compromises security.
• Computer equipment is subject to breakdown and software problems. A facility or entity that uses electronic records must make sure that functional equipment is available for those who document to prevent interruptions in the charting process.

Some nurses who have learned to electronically chart, and have never worked in a system that requires manual charting may have difficulty adjusting when computer downtime occurs.

• Devastation of medical records through computer viruses which are introduced via floppy disks or by downloading files from the internet may cause massive losses of data. Adequate backup solutions must be in place.
• The transition from paper to electronic records has to incorporate a way to capture paper documents. Forms brought to the hospital or physician office will have to be scanned to add them to an electronic record. This is time consuming and labor intensive.
• Customer services issues are created when healthcare professionals lose eye contact with the patient in favor of documenting on the computer.
• Rigidity is a problem with many electronic health records. Many records become electronic versions of checklists, which may not permit individualization for a patient. For example, the system may limit free text entries needed to clarify information.

Operational issues can have a significant impact on EMRs

From Nursing Malpractice, Fourth Edition

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